The latest from Gaza: “something out of a horror film”

The crisis before the crisis

As of 2022, the Palestinian Central Bureau of Statistics estimated the population of Palestine to be roughly 5.35 million, with 3.19 million people in the West Bank, and 2.17 million in Gaza.

The narrow strip represents one of the most densely populated areas in the world, with 2,277 residents per square mile.

According to the United Nations Office for the Coordination of Humanitarian Affairs, prior to the recent escalation, 53 percent of the population were living below the poverty line and 34 percent below the deep poverty line.

This poverty rate disproportionately affects female-headed households, which make up 10 percent of total households in Gaza, and refugee populations, which make up 68 percent of the Gazan population.

Further, the UN estimated that 63% of Gaza residents in particular were already in extreme and severe need of humanitarian assistance, including 224,000 people in north Gaza and 389,000 people in Gaza City.

To endure this escalating crisis without water or electricity – and, for 36 hours, without communications – is nearly unimaginable.

The recent evacuation and bombardments have forced Gazans in the south to convert university buildings, mosques, refugee camps, hospitals, and churches into alternative living spaces to accommodate the massive influx of displaced people from the north, but the overcrowding has been overwhelming.

Families are building makeshift tents adjacent to official shelters, and, if they can’t stay there, they simply sleep outdoors.

The United Nations Relief and Works Agency (UNRWA) has reported that many of their shelters are between 2.51 times to 11 times over capacity, and the New York Times has reported that the Al-Shifa hospital, with a normal capacity of 700 beds, “is now housing more than 60,000 people.”

An unconfirmed number of people still remain in Gaza City, taking shelter in formerly supported UNRWA facilities in the north that are no longer equipped with essential supplies of clean water or basic health services.

This was the state of the crisis before the blackout.

The heaviest impact hits the most vulnerable

An unconfirmed number of people still remain in Gaza City, taking shelter in formerly supported UNRWA facilities in the north that are no longer equipped with essential supplies of clean water or basic health services.

This was the state of the crisis before the blackout.

“The people that live in these very highly crowded emergency shelters have no water to drink and to maintain their basic hygiene to their families, to their kids, to their elderly people and to their disabled people as well,” CARE Emergency Humanitarian Coordinator in Gaza, Saaed Madhoun, said.

“Due to the large number of people in these locations, we will be seeing a catastrophic result from water borne diseases and dehydration.”

“Contagious diseases are now breaking out in a very scary way in the overcrowded shelters,” Hiba told DW.

“But unfortunately, we don’t have information on what is happening in the surrounding areas outside these shelters in the overcrowded apartments.”

Conflict is not gender neutral

CARE’s work around the world has repeatedly shown that conflict is not gender neutral. Protracted conflicts like the one in Gaza often create a landscape of multidimensional and intersectional vulnerabilities for diverse groups, compounding over time, specifically around access to food, mobility, poverty, education, protection, and employment.

CARE research has shown over and over that these vulnerabilities disproportionately affect women and girls.

Gaza is no different.

“The situation for children is for me, as a woman and a human, the worst. It breaks my heart,” Hiba told the Norwegian daily Aftenposten.

In the temporary shelters, the overcrowding and the lack of privacy present significant safety and protection risks for women and girls, and the dire conditions heighten risks of gender-based violence.

Unaccompanied women, the elderly, people with disabilities, and children have unique and urgent needs and vulnerabilities, both relating to the current conflict and due to structural gender discrimination, including laws placing women under the protection and guardianship of men.

These structures and social norms make women and girls more likely than men to be living in sub-standard temporary shelters when displaced and increase the risks of gender-based violence (GBV), sexual exploitation, and abuse.

The electricity blackout conditions and the absence of public and private partitions within the shelters also heighten already amplified levels of fear and insecurity.

Without fuel, the sole power plant in Gaza shut down on Oct. 11, leaving essential lifesaving health services for the most vulnerable and critical sanitation and water services to rely on generators operating on limited fuel, exacerbating already fragile living conditions in Gaza.

“Some of the doctors we are in touch with are using vinegar for disinfection, they can’t fulfill the minimal anesthesia requirements,” Hiba said. “They are treating people on the floor, outside the hospital. They are very tired. But still they go on with their work with outstanding courage.”

As of Friday, 30 percent of all hospitals and nearly two thirds of clinics had shut down for lack of electricity or structural damage.

Over the weekend, CARE received reports from the medical personnel it works with in Gaza that pregnant women are being forced to undergo emergency C-sections without anesthetics, and that women are being discharged within as little as three hours after giving birth.

An average of 160 pregnant women are expected to give birth every day over the next month in Gaza. CARE’s latest Rapid Gender Analysis warns that the dire conditions are exacerbating the risk of maternal and newborn mortality, which are already disproportionately high in Gaza.

“My biggest fear,” Hiba told The New York Times, “is that the bombing of Gaza won’t be the biggest threat, but that diseases and dehydration will be the bigger threat.”

CARE’s ongoing work

CARE International has been working in the West Bank and Gaza since 1948 to help women and young Palestinians realize their rights, reach their full life potential, and contribute to a vibrant, equitable, and accountable Palestinian society.

CARE studies have shown how around the world food insecurity disproportionately affects women (especially widows, refugees, and those living with disability), and women in Gaza were already twice as likely to experience unemployment, given social and cultural norms related to their caregiving roles in the private sphere and discriminatory social norms.

CARE’s women’s empowerment initiatives in Gaza and the West Bank have focused on women’s political participation and social entrepreneurship, supporting their skills and developing their agency.

This work will become even more vital going forwards, as the UN Women estimates that, because of the ongoing violence, about 900 new households will be headed by women and widows, multiplying their vulnerabilities and responsibilities.

The need for a ceasefire & how you can help

The escalation of violence in Gaza and the surrounding region has led to unprecedented stress on the most vulnerable populations and further compromises their ability to respond, adapt, and build resilience to continued shock.

“There are clear and simple rules of international humanitarian law,” Hiba said on Saturday after the blackout.

“Civilians, including humanitarian workers, must be protected, and the medical mission must be respected at all times; civilians trapped in areas where evacuation orders were issued are still protected under international law.

“I am extremely worried for what the next few days hold in store and for the safety of my team.”

To join CARE’s efforts in the Middle East, visit our Women & Families Emergency Crisis Fund page.